Provider Demographics
NPI:1366654592
Name:CITY OF BANGOR
Entity Type:Organization
Organization Name:CITY OF BANGOR
Other - Org Name:BANGOR SCHOOL DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOCHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-992-4160
Mailing Address - Street 1:73 HARLOW ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:73 HARLOW ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5118
Practice Address - Country:US
Practice Address - Phone:207-992-4160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135940200Medicaid